A Minimum Service Package (MSP) to improve response to mental health and psychosocial needs in emergency situations
Authors: Inka Weissbecker, Caoimhe Nic A. Bhaird, Vania Alves, Peter Ventevogel, Ann Willhoite, Zeinab Hijazi, Fahmy Hanna, Prudence Atukunda Friberg, Henia Dakkak, Mark van Ommeren
Journal: World Psychiatry (2023)

Emergency situations such as armed conflicts, natural disasters, epidemics and famines deeply affect people's mental health and psychosocial well-being. Globally, one in five (22.1%) people living in areas affected by a conflict during the previous ten years have mental disorders such as depression, anxiety, post-traumatic stress disorder, bipolar disorder, or schizophrenia1. For children, adverse experiences in emergencies can disrupt cognitive, emotional, social and physical development, with enduring consequences2, 3. Emergencies affect the availability of already sparse mental health services, and can erode the ability of families, caregivers and communities to support each other. Over the years, attention to mental health and psychosocial support in emergencies has grown remarkably4. Mental health has now become a routine part of primary health care interventions in humanitarian settings5. The accumulation of evidence around a suite of brief scalable psychological interventions tailored to the needs of people affected by emergencies has fueled optimism that we can effectively treat common mental health conditions with relatively modest means6, 7. But there is no reason for complacency. The grim reality is that, in humanitarian settings, mental health and psychosocial support remains insufficiently prioritized, and programming is often still fragmented, inconsistent and inequitable8. There is a recognized need for a single easy-to-use package that strengthens collective humanitarian action by facilitating a unified response, integrating mental health and psychosocial support into various sectors such as health, protection, education, gender-based violence, nutrition, shelter, and camp coordination and management. The new Mental Health and Psychosocial Support Minimum Service Package (MHPSS MSP) has been spearheaded by the World Health Organization (WHO), the United Nations (UN) International Children's Emergency Fund (UNICEF), the UN High Commissioner for Refugees (UNHCR), and the UN Population Fund (UNFPA). It is a resource for organizations which plan, support, coordinate, implement, fund and evaluate humanitarian activities. These include governments, national and international non-governmental organizations, civil society, Red Cross and Red Crescent networks, UN agencies, and financial donors. It outlines a set of activities that have the highest priority in meeting the immediate critical mental health needs of emergency-affected populations, based on existing guidelines, evidence, research, and expert consensus. Each MSP activity is presented with a brief introduction explaining why the activity is important, a checklist of actions required to implement the activity safely and effectively, a list of relevant guidelines to support implementation, and associated costs (e.g., staff salaries) for consideration. For example, the section "Provide mental health care as part of general health services" briefly explains why this is needed (e.g., better accessibility, less stigma), specifies the recommended actions (e.g., adapting training materials, ensuring supervision), and lists relevant and up-to-date guidance (e.g., the WHO mhGAP Humanitarian Intervention Guide, mhGAP-HIG). Humanitarian actors writing programme proposals can easily see what each activity entails and what budget is needed. Financial donors can use the MSP when making decisions about resource allocation. Persons coordinating the humanitarian response can see where the gaps are in different sectors (e.g., health, education), and what additional activities may be needed to meet the mental health needs of affected populations. The MSP has been developed over three years based on literature reviews, consultations, and peer review by key stakeholders in global, regional and frontline positions. The initial draft was field-tested globally, with demonstration sites in Colombia, Iraq, North-East Nigeria, South Sudan, and Ukraine. Feedback was collected from hundreds of humanitarian actors across sectors and regions. The final version will be launched by the primary coordination body for humanitarian assistance, the Inter-Agency Standing Committee (IASC). We have already received some preliminary feedback on how the MSP is informing the emergency response to the war in Ukraine. A staff member of an organization writing a regional mental health response strategy noted that the MSP allowed them to do this much more quickly and efficiently. A donor, reviewing a proposal to support psychiatric hospitals in Ukraine, observed that the MSP was helpful in understanding and evaluating the proposal. The MSP is also informing the development of a strategic mental health framework supported by the First Lady of Ukraine. The MSP is relevant to any humanitarian emergency that requires a coordinated international response. However, it can also be relevant for smaller emergencies, for disaster risk reduction (especially relevant because of the climate crisis), and for longer-term development programming. Humanitarian crises have a long-lasting impact on mental health, and it is therefore essential to work from the onset towards mental health and social care systems that can be sustained over time9. The use of the MSP is expected to lead to better coordinated and more predictable, timely, and evidence-informed responses that make effective use of limited resources and improve the scale and quality of programming. It has the potential to be transformative and to give a major boost by prioritizing activities, providing a shared language for advocacy and planning, and supporting coordinated implementation of activities. This should ultimately lead to better mental health outcomes for large numbers of emergency-affected people, including vulnerable groups, who often receive less attention and investment.